An Assessment of Methods Used to Evaluate the Adequacy of Cancer Pain Management

This paper assesses different methods of evaluating pain management. We used the established methods of pain prevalence measurement and the Pain Management Index (PMI) to compare pain management between two groups who might be expected to have different outcomes. We also developed and used a method to assess how quickly pain was controlled for each group (time to pain control). We compared a group of cancer patients (n = 712) managed by general practitioners in the community (Community Group) and a group of patients (n = 152) treated in a Specialist Palliative Care Unit (Hospice Group) using all methods. The time to pain control method identified a significant difference between the two groups (P < 0.01 log rank test), with the Hospice Group achieving pain control significantly faster. By contrast, neither the pain prevalence method nor the PMI could detect any difference (P = 0.11 Wilcoxon test). The established methods of pain prevalence measurement and PMI are limited by their inability to measure pain over time and to assess prescribers' response to changing pain. Dynamic methods that evaluate changes in prescribing and pain levels over time must be developed in order to accurately assess pain management.